糖尿病足的病原体分布及其耐药性分析  

Distribution and Drug Resistance of Pathogenic Bacteria in Patients with Diabetic Foot

作　　者：金华伟[1] 朱麒钱[1] 吴东东 斯徐伟[1] 官莉莉[1] 俞钟明[1] 楼大钧[1] 

机构地区：[1]浙江省绍兴市人民医院内分泌科,312000 [2]检验科细菌室

出　　处：《中国全科医学》2008年第2期142-144,共3页Chinese General Practice

摘　　要：目的探讨本地区糖尿病足感染病原体分布及其耐药性,为临床合理应用抗菌药物提供依据。方法对糖尿病足感染患者的创面分泌物进行细菌和真菌培养,用K-B法或稀释法行药敏试验。结果95例糖尿病足感染分泌物标本中69例(72.6%)培养出病原体,分离出病原体106株,其中革兰阳性菌51株(占48.1%),革兰阴性菌50株(占47.2%),真菌5株(占4.7%);产超广谱β-内酰胺酶(ESBLs)的细菌15株,占肠杆菌科细菌的34.1%。糖尿病足感染以凝固酶阴性葡萄球菌、金黄色葡萄球菌、变形杆菌和大肠埃希菌为主,也可见真菌感染。药敏试验结果提示多重交叉耐药,革兰阴性菌对亚胺培南及加β-内酰胺酶抑制剂的抗菌药物较为敏感,革兰阳性菌对万古霉素、氯霉素及头孢菌素较敏感;大肠埃希菌对常用抗菌药物均有耐药;凝固酶阴性葡萄球菌和肠球菌除万古霉素外,对其他临床常用抗菌药物也均有耐药性。结论糖尿病足感染的病原体分布广泛,对抗菌药物耐药率高,应选择广谱抗菌药物联合用药。Objective To study the distribution and drug resistance of pathogenic bacteria in patients with diabetic foot to provide a basis for reasonable application of antibioes in our district. Methods Excretion specimens from raw surface of diabetic - foot - infected patients was cultured to do susceptibility test by K - B or dilution method. Results Among the 95 excretion specimens from diabetic - foot - infected patients, 69 （72 6% ） were cultured out bacteria and disjtmcted out 106 strains of pathogenic bacteria （ PB）, of which 51 （48 1% ） were gram - positive bacteria （ GPB）, 50 （47 2% ） gram - negative baetena （GNB）, 5 （4 7% ） eumycete; and of which 15 strains of extended spectruml31actamases （ESBL） were found （ 34 1% of enterobacteriaeeae）. Diabetic foot infection was mainly from coagulase negative staphylococcus （ CN - S）, staphylococcus aureus （SA）, bacillus proteus （BP） and Escherichia coli （ E coli） ; and fungous＇infection （FI） was also detected. According to susceptibility test, multi - cross drug resistance was found ,. GNB was sensitive to imipenem and antibiotic filled with βlactamases inhibitor, and GPB to vancocin, amphemycin, and cephalosporin ; E coli was drug- fast to commonly -used antibiotic, and CN - S and enterococcus was drug - fast to other clinical commornly - used antibiotic except vancocin. Conclusion The pathogenic bacteria in diabetic foot infection distribute extensively and some of them are multi - cross drug resistant. Bacteria producing ESBLs assume an spreading tendency. Broad -spectrum antibiotics should be used in patients wiih diabetic foot infection at the initial stage.

关 键 词：糖尿病足 细菌感染和真菌病 抗茵药 抗药性 

分 类 号：R587.23[医药卫生—内分泌]